Energy Benchmark Form

Free Energy Benchmark Form

Company Information

Company:

Address 1:

Address 2:

City:

State:

Zip:

Facility Type:

Contact Information

First Name:

Last Name:

Email:

Phone:

Fax:

Utility Records Release Agreement

I the undersigned identified below hereby authorize Facility Management and Engineering, 4928 Plaza East Blvd, Evansville Indiana 47715 to act on my behalf for the purpose of obtaining 24 consecutive months’ utility bills. Bills will be used for the sole purpose of an energy benchmark of the facility addressed above utilizing the DOE Energy Star program. Energy use documents shall be held in confidence.

Electric Utility:

Account #:

Gas Utility:

Account #:

Water Utility:

Account #:

I have read and agree to the terms of the 'Utility Records Release Agreement'.

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